Upward Bound Program Kilgore College
2020-2021 Updated Student Information
Date:
_________________
High School: ___________________________________ Grade Level: _________
Student Name:
_
____________________________________________________________________________________
First
Middle Initial
Last
Mailing Address:
___________________________________________________________________________________
Street Address
Apt. #, if applicable
City:
______________________________________
State:
__________
Zip code:
_______________________________
Home Phone:
________________________________
Student Cell: ______________________________________________________
Student E-mail: _________________________________________________________________ T-Shirt Size: _________________________________
Skyward Log-In:
________________________________
Skyward Password: ______________________________________________
PARENT/GUARDIAN CONTACT INFORMATION:
Please list two contact names if possible.
Name: _
______________________________________________
Relationship to Student: ________________________________
First
Last
Home Phone: _______________________________________________ Work Phone:
______________________________________
Cell Phone:
_______________________________________
E-mail: ______________________________________________________
Employed by:
______________________________________________________________________________________
Mailing address same as student? _______ YES _______
if NO
please update below: __________________________________________
__________________________________________________________________________________________________________________________
Name: _
______________________________________________
Relationship to Student: ________________________________
First
Last
Home Phone: _______________________________________________ Work Phone:
______________________________________
Cell Phone:
_______________________________________
E-mail: ______________________________________________________
Employed by:
______________________________________________________________________________________
Mailing address same as student? _______ YES _______
if NO
please update below: __________________________________________
__________________________________________________________________________________________________________________________
For Parents:
Which days/times are typically best for you to attend any parent meetings throughout the academic year?
Day(s) of the week: ______________________________ Times (circle): Before noon Before 5pm Between 5pm-7pm After 7pm
*If times available differ by day, please explain: ________________________________________________________________________
